Spine surgery method and inserter

ABSTRACT

A surgical inserter for use in inserting an implant into a vertebral space may include: (a) a handle; (b) a gripper having one end attached to the handle and a second end having a pair of arms; and (c) a grip activator having an opening that threadingly receives the gripper. The grip activator can be rotated in a first direction with respect to the gripper to cause the arms to move toward each other to grip the inserter and in a second direction with respect to the gripper to cause the arms to move away from each other to release the inserter. In one embodiment a compression force activator is used to deploy the implant and in another embodiment a tension force activator is used to deploy the implant.

I. BACKGROUND OF THE INVENTION

A. Field of Invention

This invention pertains to the art of methods and apparatuses regardingspine surgery and more specifically relates to surgical procedures andan inserter used to position an implant, and perhaps to deploy theimplant, within a vertebral space.

B. Description of the Related Art

The volume of spinal surgeries to treat degenerative disc and facetdisease has steadily increased over the past decade, fueled bypopulation demographics and advancements in diagnostic andinstrumentation adjuncts. Improvements in intraoperative radiologicalimaging and surgical technique have generated a great deal of interestin applying minimally invasive surgical (MIS) techniques to spinalapplications. As in other surgical subspecialties, it is hoped suchminimally invasive techniques applied to spinal surgery will result inless soft tissue trauma, less operative blood loss, reduced operativetime, faster recovery periods and lower costs.

Known spinal surgical techniques, though generally working well fortheir intended purposes, have been adopted from traditional opensurgical (non-MIS) techniques. As a result, known spinal surgicalmethods, instrumentation and interbody implants have limitations. Onelimitation is that the physical components are relatively large andbulky. This reduces surgeon visualization of the surgical site. Anotherlimitation of known spinal surgical methods is that known surgical toolsand implants are cumbersome and difficult to maneuver within the limitedsurgical space available. The limitations of current instrumentation inMIS spine surgery are noted particularly with regards to interbodyfusion surgery.

The present invention provides methods and apparatuses for overcomingthese limitations by providing a surgical inserter that allows forminimally invasive spinal surgery and that provides for precisemovement, placement and deployment of an implant into the vertebralspace.

II. SUMMARY OF THE INVENTION

According to one embodiment of this invention, a surgical inserter foruse in inserting an implant into a vertebral space comprises: (1) ahandle having first and second ends for use by a surgeon; and, (2) animplant gripping mechanism comprising: a gripper having a first endattached to the second end of the handle and a second end having a pairof arms; and, a grip activator having an opening that threadinglyreceives the gripper. The grip activator can be rotated in a firstdirection with respect to the gripper to cause the arms to move towardeach other to grip the inserter and can be rotated in a second directionwith respect to the gripper to cause the arms to move away from eachother to release the inserter.

According to another embodiment of this invention, the surgical inserterfurther comprises: a connector having a first end attached to the secondend of the handle and a second end attached to the first end of thegripper.

According to another embodiment of this invention, the surgical inserterfurther comprises: an implant deployment mechanism for use in deployingthe implant.

According to still another embodiment of this invention, the implantdeployment mechanism comprises: (1) a compression force member; and, (2)a compression force activator that can apply a force to the compressionforce member to extend the compression force member into contact withthe implant.

According to yet another embodiment of this invention, the implantdeployment mechanism comprises: (1) a tension force member that isoperatively connected to the implant; and, (2) a tension force activatorthat can apply a tension force to the tension force member to deploy theimplant.

According to another embodiment of this invention, the surgical inserterfurther comprises: an implant anti-deployment mechanism for use inpreventing the implant deployment mechanism from operating until thesurgeon is ready to operate it.

According to another embodiment of this invention, the implantanti-deployment mechanism comprises: a tube member that can contact theimplant; and, a securing device for use in securing the tube member incontact with the implant to prevent deployment of the implant.

According to still another embodiment of this invention, a methodcomprises the steps of: (A) providing an implant made to be placed intoa vertebral space; (B) providing a surgical inserter comprising: ahandle having first and second ends for use by a surgeon; a gripperhaving a first end attached to the second end of the handle and a secondend having a pair of arms; and, a grip activator having an opening inthat threadingly receives the gripper; (C) preparing the vertebral spaceto receive the implant; (D) rotating the grip activator with respect tothe gripper to cause the arms to move toward each other to grip theinserter; (E) moving the surgical inserter to insert the implant withinthe vertebral space; (F) rotating the grip activator with respect to thegripper to cause the arms to move away from each other to release theinserter; and, (G) moving the surgical inserter away from the vertebralspace.

According to another embodiment of this invention, the method mayfurther comprise the step of: deploying the implant with the inserter.

According to another embodiment of this invention, the method mayfurther comprise the step of: adjusting an anti-deployment mechanism topermit deployment of the implant.

One advantage of this invention is that the inventive surgical inserterpermits an implant to be relatively easily placed into a vertebralspace.

Another advantage of this invention is that the implant may berelatively easily and securely attached to the inserter and thendetached from the inserter.

Another advantage of this invention is that the surgeon may makeconsistent and reproducible biplanar, midline placement of the interbodyimplant.

Another advantage of this invention is that, in one embodiment, theinserter can be used to deploy the implant.

Yet another advantage of this invention is that the surgical inserterallows for minimally invasive deployment via either an anterior,anterolateral, posterior or posterolateral approach, with the latterapproach possible via either a transforaminal or extraforaminalapproach.

Still other benefits and advantages of the invention will becomeapparent to those skilled in the art to which it pertains upon a readingand understanding of the following detailed specification.

III. BRIEF DESCRIPTION OF THE DRAWINGS

The invention may take physical form in certain parts and arrangement ofparts, embodiments of which will be described in detail in thisspecification and illustrated in the accompanying drawings which form apart hereof and wherein:

FIG. 1A is a side perspective view of a spinal segment showing avertebral space defined by the intradiscal space usually occupied by adisc between two adjacent vertebral bodies.

FIG. 1B is a side perspective view of a spinal segment showing avertebral space defined by the space usually occupied by a vertebralbody and its two adjacent discs.

FIG. 2 is a side view of an inserter according to one embodiment of thisinvention.

FIG. 3 is a perspective proximal end view of a handle according to oneembodiment of this invention.

FIG. 4 is a perspective distal end view of the handle shown in FIG. 3.

FIG. 5 is a side sectional view of the handle shown in FIG. 3.

FIG. 6 is a perspective proximal end view of a connector according toone embodiment of this invention.

FIG. 7 is a perspective distal end view of the connector shown in FIG.6.

FIG. 8 is a perspective distal end view of a gripper according to oneembodiment of this invention.

FIG. 9 is a side view of the gripper shown in FIG. 8.

FIG. 10 is a perspective proximal end view of the gripper shown in FIG.8.

FIG. 11 is a close up perspective view of the distal end of the grippershown in FIG. 8.

FIG. 12 is a close up perspective distal end view of the gripper shownin FIG. 8.

FIG. 13 is a perspective view of the proximal end of the gripper shownin FIG. 8 but showing a deployed implant gripped by the gripper.

FIG. 14 is a perspective proximal end view of the gripper shown in FIG.13.

FIG. 15 is a perspective proximal end view of a grip activator accordingto one embodiment of this invention.

FIG. 16A is a perspective distal end view of the grip activator shown inFIG. 15.

FIG. 16B is a perspective view of the grip activator similar to thatshown in FIG. 15 but shown as if transparent so that the thread regioncan be seen.

FIG. 17 is a side view of the gripper being received by the gripactivator.

FIG. 18 is a perspective view of the gripper and grip activator similarto that shown in FIG. 17 but showing the grip activator as iftransparent.

FIG. 19 is a perspective distal end view of a screw according to oneembodiment of this invention.

FIG. 20A is a side sectional view of the handle, the screw, acompression knob and a cap according to one embodiment of thisinvention.

FIG. 20B is a side sectional view of the handle and a side view of acompression trigger mechanism according to one embodiment of thisinvention.

FIG. 20C is a side sectional view of the handle, the screw, a tensionknob and a cap according to one embodiment of this invention.

FIG. 20D is a perspective sectional view of the handle, a tension knoband a cap according to another embodiment of this invention.

FIG. 20E is a side sectional view of the handle and a side view of atension trigger mechanism according to one embodiment of this invention.

FIG. 21 is a perspective proximal end view of the tension knob accordingto one embodiment of this invention.

FIG. 22 is a perspective distal end view of the tension knob shown inFIG. 21.

FIG. 23 is a perspective proximal end view of the cap according to oneembodiment of this invention.

FIG. 24 is a perspective distal end view of the cap shown in FIG. 23.

FIG. 25 is a side sectional view of the cap shown in FIG. 23.

FIG. 26 is a perspective proximal end view of a tube member according toone embodiment of this invention.

FIG. 27 is a view of the tube member similar to that shown in FIG. 26but showing a nut attached to the tube member.

FIG. 28 is a perspective proximal end view of the nut.

FIG. 29 is a perspective distal end view of the tube member shown inFIG. 26.

FIG. 30 is a close-up view of the distal end of the inserter showing anattached implant in a non-deployed condition.

FIG. 31 is a perspective distal end view showing the inserter attachedto a deployed implant.

FIG. 32 is a close-up top view of the distal end of the inserter showndeploying an implant according to one embodiment.

FIG. 33 is a close-up perspective view of the inserter and implant shownin FIG. 32.

FIG. 34 is a perspective view of an implant in a deployed conditionaccording to one embodiment of this invention.

FIG. 35 is a perspective view of the implant shown in FIG. 34 butindicating how a cable may be removed.

FIG. 36 is a perspective view of the implant shown in FIG. 34 but in anon-deployed condition.

FIG. 37 is a perspective view of the implant similar to that shown inFIG. 36 but with the upper limbs removed for clarity.

FIG. 38 is a perspective view of an implant in a deployed conditionaccording to another embodiment of this invention.

FIG. 39 is a perspective view of the implant shown in FIG. 38 but withthe upper limbs removed for clarity.

FIG. 40 is a perspective view of the implant shown in FIG. 39 butillustrating the cable being threaded through the upper hole in post 4.

FIG. 41 is a perspective view of the implant shown in FIG. 40 butillustrating the cable being threaded through the upper hole in post 2.

FIG. 42 is a perspective view of the implant shown in FIG. 41 butillustrating the cable being threaded through the upper hole in post 1

FIG. 43 is a perspective view of the implant shown in FIG. 42 butillustrating the cable being wrapped around post 1 in acounter-clockwise manner.

FIG. 44 is a perspective view of the implant shown in FIG. 43 butillustrating the cable being threaded through the lower hole in post 2.

FIG. 45 is a perspective view of the implant shown in FIG. 44 butillustrating the cable being threaded through the lower hole in post 4.

FIG. 46 is a perspective view of the implant shown in FIG. 45 butillustrating the cable threading completed.

FIG. 47 shows various views of the insertion and deployment of theimplant with a 20 degree insertion angle and with a 30 degree insertionangle.

FIG. 48 shows various views of the insertion and deployment of theimplant with a 45 degree insertion angle.

FIG. 49A is a perspective view of a screw showing how a cable may beattached using a set screw.

FIG. 49B is a perspective view of a screw showing how a cable may beattached using a collar.

FIG. 49C is a perspective view of a screw showing how a cable may beattached using a reel member.

FIG. 50 is a close-up top view of the distal end of the inserter showndeploying an implant in the closed or non-deployed condition accordingto another embodiment.

FIG. 51 is a close-up top view similar to that shown in FIG. 50 but withthe implant shown in the open or deployed condition.

IV. DETAILED DESCRIPTION OF INVENTION

Referring now to the drawings wherein the showings are for purposes ofillustrating embodiments of the invention only and not for purposes oflimiting the same, the surgical inserter 200 of this invention can beused to insert and, in some embodiments such as shown in FIGS. 30 and31, deploy an implant 100 into a vertebral space 22. By vertebral spaceit is meant the space in a spinal column where the implant 100 will beplaced. In one embodiment, shown in FIG. 1A, a spinal segment 10 is madeup of two vertebrae 12, 14 attached together by ligaments with a disc 16separating them. Facet joints 18 fit between the two vertebrae 12, 14and allow for movement. The neural foramen 20 between the vertebrae 12,14 allow space for the nerve roots to travel freely from the spinal cord28 to the body. If it is required to remove the disc 16 and replaced itwith an implant 100, the space occupied by the disc 16, the intradiscalspace between the two adjacent vertebral bodies 12, 14, defines thevertebral space 22. In another embodiment, shown in FIG. 1B, a spinalsegment 30 is made up of three vertebrae 32, 34, 36 attached together byligaments. If it is required to remove the middle vertebra 34 (it isshown diseased) along with the adjacent discs 38, 40, such as may berequired because of a corpectomy defect, and replaced them with animplant 100, the space between the two outer vertebral bodies 32, 36,defines the vertebral space 22. It should be understood that these aresimply two non-limiting examples of the vertebral space 22 into which animplant 100 can be inserted according to this invention because anyvertebral space chosen with the sound judgment of a person of skill inthe art can be used. As the components and operation of a spinal columnis well known to those of skill in the art, further detail will not beprovided here.

With reference now to FIG. 2, the inserter 200 of this invention in someembodiments may include a handle mechanism 300, an implant grippingmechanism 400, an implant deployment mechanism 500, and an implantanti-deployment mechanism 600. Each of these mechanisms will bedescribed in more detail below. Note that throughout this patent theterm “proximal” shall refer to direction A as shown in FIG. 2 (towardthe handle end of the inserter) and the term “distal” shall refer todirection B as shown in FIG. 2 (toward the implant end of the inserter).These terms are not used to limit this invention in any way but only toprovide a direction reference.

With reference now to FIGS. 2-5 the handle mechanism 300 includes ahandle 302 that may be held by the surgeon and used to manipulate theinserter 200 during surgery. The handle 302 may be generally cylindricaland may have an opening 304 throughout its length. This opening 304 canbe used for purposes described below and may be positioned substantiallyin the radial center of the handle 302. The outer surface of the handle302 may be contoured along the handle length, as shown, and may have atextured region 306 to improve the grip for the surgeon. The proximalend of the handle 302 may be adapted to attach to the implant deploymentmechanism 500 and may include a pair of proximal holes 308, 309 for thispurpose. The distal end may be adapted to attach to the implant grippingmechanism 400 and may include a distal hole 310 for this purpose.

With reference now to FIGS. 2 and 4-7, while in one embodiment theimplant gripping mechanism 400 attaches directly to the distal end ofthe handle 302, for the embodiment shown the handle mechanism 300includes a connector 360. A connector provides for ease of assembly;namely a “quick connect” type attachment and may also make it easier toclean the inserter components. The connector 360 may have an opening 362throughout its length for purposes described below and may be positionedsubstantially in the radial center of the connector 360. The proximalend of the connector 360 may have a generally rectangular cross-sectionand may be adapted to attach to the distal end of the handle 302. Agroove 364 may be formed in the connector 360, as shown. While thegroove 364 is shown on one side of the connector 360 is to be understoodthat this groove could be positioned elsewhere and could, in anotherembodiment, be replaced with a hole extending through the connector 360.To attach the connector 360 to the handle 302, the proximal end of theconnector 360 is inserted into the opening 304 at the distal end of thehandle 302 until the connector groove 364 and the handle distal hole 310are aligned. A dowel pin (not shown) may then be inserted through thedistal hole 310 and groove 364 to secure the connector 360 to the handle302. In one embodiment, shown, the substantially square cross-section ofthe proximal end of the connector 360, when received within thesubstantially circular cross-section of the opening 304 in the distalend of the handle 302, helps to prevent relative motion and therebyhelps to maintain the inserter components in proper position as theinserter 200 is used.

With continuing reference to FIGS. 2 and 4-7, the distal end of theconnector may bc generally cylindrical and may have an outer surfacethat is contoured along the connector length and may have a texturedregion 366 to improve the grip for the surgeon. The distal end may beadapted to attach to the implant gripping mechanism 400 and the distalend of the opening 362 may have a specific shape for this purpose. Theopening shape shown has a cross-section that is semi-circular with aflat edge 368 but it is to be understood that the opening shape can beany chosen with the sound judgment of a person of skill in the art inorder to attach to the implant gripping mechanism 400.

With reference now to FIGS. 2 and 7-14, the implant gripping mechanism400, which is used to grip and release the implant 100, will now bedescribed. The implant gripping mechanism 400 includes a gripper 420that may be generally cylindrical and may have an opening 422 throughoutits length. This opening 422 can be used for purposes described belowand may be positioned substantially in the radial center of the gripper420. The proximal end of the gripper 420 may be adapted to attach to thedistal end of the connector 360. More specifically, the proximal end ofthe gripper 420 may be shaped to fit into the distal end of the opening362 formed in the connector 360. For the embodiment shown, the proximalend of the gripper 420 has a cross-section that is semi-circular with aflat edge 440 to match the opening 362. To further secure the proximalend of the gripper 420 to the distal end of the connector 360, thegripper 420 may have a circumferential groove 424 that is received in amating extension (not shown) that extends from the opening 362 withinthe connector 360.

With continuing reference to FIGS. 2 and 7-14, the distal end of thegripper 420 may be used to both grip and release the implant 100. A pairof arms 426, 427, forming a V-shape, may extend outwardly and end with apair of hands 428, 429, respectively, as shown. There is a space 430between the arms 426, 427 which can be narrowed as will be describedfurther below. Each hand 428, 429 has a contact surface 432 that is usedto physically contact a surface of the implant 100. As shown, one hand428 has a gap 434 between two hand portions for a purpose to bedescribed below. However, other embodiments would also work well withthis invention. Neither hand, for example, may have a gap. In anotherembodiment, three or more hand portions may be used. The contact surfaceof each hand portion may be textured, as shown, to improve the grippingcharacteristics of the hands 428, 429. The other hand 429 may have acontinuous contact surface 432 and may include a tang 436 positionedsubstantially central to the hand, as shown. The tang 436 is also usedto improve the gripping characteristics of the hands 428, 429. In onespecific embodiment, the tang 436 is adapted to be received within acorresponding groove 102 (see FIG. 14) formed in the implant. In otherembodiments, multiple tangs and/or multiple grooves may be used. Itshould be understood that the contact surfaces 432 described here arenon-limiting examples because the contact surfaces 432 used can be anychosen with the sound judgment of a person of skill in the art.Positioned proximally from the arms 426, 427 the outer surface of thegripper 420 has a threaded region 438 for purposes to be describedbelow.

With reference now to FIGS. 2 and 11-18, the implant gripping mechanism400, may also include a grip activator 460 which can be used by thesurgeon to activate the gripper 420 to grip or release the implant 100.The grip activator 460 may be generally cylindrical and may have anopening 462 throughout its length. This opening 462 may be positionedsubstantially in the radial center of the grip activator 460 and may beused to receive the gripper 420, as shown. The proximal end of the gripactivator 460 may have an outer surface having a textured region 464 toimprove the grip for the surgeon. The proximal end of the grip activator460 may be adapted to attach to and activate the gripper 420. In aspecific embodiment, the opening 462 may be at least partially definedby a threaded region 466 (see FIGS. 16A and 18) that engages thethreaded region 438 of the gripper 420, for purposes to be describedbelow.

With reference now to FIGS. 2, 30 and 31, the implant deploymentmechanism 500, which is used to deploy an implant will now be described.First, however, it should be noted that the term “deploy” as used inthis patent refers to any adjustment of an implant after the implant hasbeen initially placed into the vertebral space that involves relativemotion of one portion of the implant with respect to another portion ofthe implant. Non-limiting examples of deployment include implants thathave one portion that pivots or moves curvilinearly with respect toanother portion and implants that have one portion that slides or moveslinearly with respect to another portion. Implants that expand in anymanner and in any direction fall under the definition of “deploy.”Second it should be noted that not all implants may require deployment.If this is the case, it should be noted that the inserter 200 of thisinvention as described above will work well to insert such an implant.Third, it should be noted that the inventors contemplate multipledevices and methods for deploying an implant. While specific embodimentswill be described, they should not be understood to be limiting butrather exemplary only.

With reference now to FIGS. 2, 13, 20A, 20B, 32-33 and 50-52, in oneembodiment a compression force is used to deploy the implant 100. Inthis case, a compression force member may be used to “push” or “shove”the implant 100 for deployment. In one specific embodiment, thecompression force member is a rigid rod or wire 520 that is positionedwithin the handle opening 304, the connector opening 362, and thegripper opening 422. To deploy the implant 100 it is only necessary toapply a compression force to the proximal end of the wire 520 causingthe wire 520 to move in the distal direction B until the distal end ofthe wire 520 extends out of the distal end of the gripper 420 andcontacts the implant 100 for deployment, as shown for example in FIGS.32 and 50. This compression force can be activated by the surgeon usinga compression force activator 700.

With reference now to FIGS. 2, 13, 20A, 20B, 32 and 33, in oneembodiment, shown in FIG. 20A, the compression force activator 700includes a screw 702 and a compression knob 704. The screw 702 may begenerally cylindrical and may have a contact surface 706 at its distalend that is used to contact and move the compression force member 520.The screw 702 may also have an opening 720 throughout its lengthsubstantially in the radial center of the screw 702 that receives thecompression force member 520. The outer surface of the screw 702 mayhave a threaded region 708 to engage the compression knob 704 as will bedescribed below. While the threaded region 708 is shown to substantiallycover the entire outer surface of the screw 702, it is to be understoodthat the threaded region 708 need not be that big. It is only necessaryfor the threaded region 708 to be sufficient in size to accomplish thepurpose of this invention as determined with the sound judgment of aperson of skill in the art. The distal end of the screw 702 may bcinserted into the handle opening 304 on the proximal end of the handle302 and may, in a more specific embodiment, threadably engage threadsformed on the inside diameter of the proximal end of the handle opening304. In an alternate embodiment, the proximal end of the handle opening304 does not include threads that engage the threaded region 708 of thescrew 702.

With reference now to FIGS. 2, 19, 20A and 23, the compression knob 704may be used by the surgeon to increase or decrease compression force onthe compression force member 520 during surgery. The compression knob704 may be generally cylindrical and may have an opening 710 throughoutits length that may be positioned substantially in the radial center ofthe compression knob 704. The compression knob 704 may have a threadedregion 712 defining at least a portion of the outer edge of the opening710 to engage with the threaded region 708 of the screw 702. The outersurface of the compression knob 704 may be contoured along thecompression knob length, as shown, and may have a textured region 714 toimprove the grip for the surgeon. The proximal end of the compressionknob 704 may be adapted to attach to a cap 580 as will be describedfurther below. More specifically, the compression knob 704 may have asecond threaded region 716 defining at least a portion of the outer edgeof the opening 710 (which may have a greater diameter, as shown) toengage with a threaded region 582 of the cap 580. The distal end of thecompression knob 704 may be adapted to engage the proximal end of thescrew 702. More specifically, the distal end of the compression knob 704may include a “nut-like” portion 718 having an outer surface that issubstantially shaped as a typical nut used to receive a bolt. Rotationof the compression knob 704 in a first direction F1 causes the screw 702to move in the distal direction B with respect to the handle 302 untilthe contact surface 706 of the screw 702 contacts the proximal end ofthe compression force member 520. Continued rotation of the compressionknob 704 in the first direction F1 causes the screw 702 and thecompression force member 520 to move in the distal direction B so thatthe distal end of the compression force member 520 can contact theimplant 100. Rotation of the compression knob 704 in a second directionF2 causes the screw 702 to move in the proximal direction A and reducesthe force on the compression force member 520. For this embodiment, thecompression knob 704 does not move distally or proximally with respectto the handle 302 as it is rotated.

With reference now to FIGS. 2, 19, 20A and 23-25, in one embodiment thepreviously mention cap 580 may be used with the inserter 200 of thisembodiment. The cap 580 may be generally cylindrical and may have anopening 584 extending partially through its length that may bepositioned substantially in the radial center of the cap 580. The outersurface of the cap 580 may be contoured along the cap length, as shown.The proximal end of the cap 580 may have an outer surface 586 that isadapted to receive a direct force from a surgical mallet, slap hammer orthe like for use in positioning the inserter 200. For this reason thecap 580 is preferably centered on the longitudinal axis of the inserter200. It should be noted, however, that the cap 580 can be positionedanywhere chosen with the sound judgment of a person of skill in the art.The distal end of the cap 580 may be adapted to receive the proximal endof the screw 532 and to attach to the proximal end of the compressionknob 704. In a specific embodiment, the distal end of the cap 580 mayhave an outer surface with a threaded region 582 that engages the secondthreaded region 716 of the compression knob 704. The opening 584 mayreceive the proximal end of the screw 702 as the compression knob 704 isrotated as explained above. It should also be noted that the cap 580 canbe easily removed to access the screw 702 and the compression forcemember 520 for loading and removal of the compression force member 520from the implant 200.

With reference now to FIGS. 20B, 32-33 and 50-51, in another embodimentshown in FIG. 20B, the compression force activator 700 is a compressiontrigger mechanism 750. The compression trigger mechanism 750 may includea body 752, a hold member 754 and a trigger 756. The trigger 756 mayhave a contact surface 758 at a first end that is used to contact andmove the compression force member 520. At the second end, the trigger756 may have a grip surface 760. Between its ends, the trigger 756 maybe pivotally connected, such as with a pivot pin 762, to the body 752 orto the hold member 754. The distal end of the body 752 may be connectedto the proximal end of the handle 302 in any manner chosen with thesound judgment of a person of skill in the art. The body 752 may have anopening 764 that is collinear with the opening 304 formed in the handle302. To increase the compression force on the compression force member520 during surgery, the surgeon simply places the hold member 754 inhis/her palm, places his/her fingers on the grip surface 760 of thetrigger 756 and squeezes. This squeezing causes the second end of thetrigger 756 to move in proximal direction A and to thus pivot thetrigger 756 about pivot pin 762. This motion in turn causes the contactsurface 758 to move in distal direction B until the contact surface 758contacts the proximal end of the compression force member 520. Continuedsqueezing of the trigger 756 causes the compression force member 520 tomove in the distal direction B so that the distal end of the compressionforce member 520 can contact the implant 100.

With reference now to FIGS. 2, 13, 19, 20C and 34-46, in anotherembodiment a tension force is used to deploy the implant 100. In thiscase, a tension force member may be used to “pull” on some portion ofthe implant 100 for deployment. In one specific embodiment, the tensionforce member is a cable 560 that is positioned within the handle opening304, the connector opening 362, and the gripper opening 422. To deploythe implant 100 it is only necessary to apply a force to the proximalend of the cable 560 causing the cable 560 to move in the proximaldirection A until the desired motion occurs at the implant 100. Thistension force can be activated by the surgeon using a tension forceactivator 530. In one embodiment, the tension force activator 530includes a screw 532 and a tension knob 550. The screw 532, as seen bestin FIGS. 19-20, may be generally cylindrical and may have an opening 534throughout its length substantially in the radial center of the screw532 that receives the cable 560. The outer surface of the screw 532 mayhave a threaded region 536 to engage the tension knob 550 as will bedescribed below. While the threaded region 536 is shown to substantiallycover the entire outer surface of the screw 532, it is to be understoodthat the threaded region 536 need not be that big. It is only necessaryfor the threaded region 536 to be sufficient in size to accomplish thepurpose of this invention as determined with the sound judgment of aperson of skill in the art. The screw 532 may also have one or morespherical radii 538 (four used in the shown embodiment).

With reference now to FIGS. 2, 5, 19 and 20C, the distal end of thescrew 532 may be inserted into the handle opening 304 on the proximalend of the handle 302. At least one ball plunger 540 (two used in theshown embodiment) may be inserted into the proximal holes 308, 309formed in the proximal end of the handle 302. Each ball plunger 540engages one of the spherical radii 538 to secure the screw 532 to thehandle 302 in a manner known in the art. The proximal end of the screw532 may extend out of the handle 302 and engage the tension knob 550 aswill be described below.

With reference now to FIGS. 2, 19, 20C and 23, the tension knob 550 maybe used by the surgeon to increase or decrease tension force on thecable 560 during surgery. The tension knob 550 may be generallycylindrical and may have an opening 552 throughout its length that maybe positioned substantially in the radial center of the tension knob550. The tension knob 550 may have a threaded region 554 defining atleast a portion of the outer edge of the opening 552 to engage with thethreaded region 536 of the screw 532. The outer surface of the tensionknob 550 may be contoured along the tension knob length, as shown, andmay have a textured region 556 to improve the grip for the surgeon. Inone embodiment, the proximal end of the tension knob 550 may be adaptedto attach to the cap 580. More specifically, the tension knob 550 mayhave a second threaded region 558 defining at least a portion of theouter edge of the opening 552 (which may have a greater diameter, asshown) to engage with a threaded region 582 of the cap 580. The cap 580can be easily removed to access the tension force member 560. The distalend of the tension knob 550 may be adapted to engage the proximal end ofthe screw 532. More specifically, the distal end of the tension knob 550may include a “nut-like” portion 559 having an outer surface that issubstantially shaped as a typical nut used to receive a bolt.

With reference now to FIGS. 2, 19, 20C, 49A, 49B and 49C, the tensionforce member, which may be cable 560, may be attached to the implantdeployment mechanism 500 in any manner chosen with the sound judgment ofa person of skill in the art. In one embodiment, the cable 560 isattached to the screw 532. In one more specific embodiment shown in FIG.49A, a set screw 800 may be received in a hole formed in the proximalend of the screw 532. The proximal end of the cable 560 can be wrappedaround the set screw 800 and the set screw 800 can then be tightened tothe screw 532 to secure the cable 560. For one embodiment using bothcable 560 ends or in another embodiment where two cables 560 are used, apair of set screws 800, 800 may be used to secure the cable(s) as shown.In another embodiment shown in FIG. 49B, one or more collars 802 may beattached to the screw 532. A cable end is then inserted through anopening 804 in the collar 802 and the collar 802 is rotated to tightenagainst the cable 560, to secure the cable 560, in a manner known in theart. In yet another embodiment shown in FIG. 49C, a reel device 806 maybe attached to the screw 532. A cable end is then received on androtated about the reel device 806 to secure the cable 560 in a mannerknown in the art. While the previous discussed concerned variousembodiments for attaching the cable 560 to the screw 532, it should beunderstood that the same embodiments could also be used to attach thecable 560 to another portion of the inserter 200, such as to the tensionknob 550. It should also be understood that while the set screw 800,collar 802 and reel device 806 where described as receiving one cableend, they each could receive multiple cable ends or non-end portions ofthe cable 560. In this case, only one set screw 800, collar 802 or reeldevice 806 is required even if multiple cables or cable portions aresecured to the implant deployment mechanism 500.

With reference now to FIGS. 19 and 20D, in another embodiment thetension knob 550 may be used without the previously described screw 532.The tension knob 550 may be attached to a rotatable shaft 562 that canbe rotated by the tension knob 550 and about which the cable 560 can bewound. The tension knob 550 may extend laterally from the inserter 200,as shown. The tension knob 550 may, in one embodiment, be ratcheted sothat successive turns of the tension knob 550 increase the tension onthe cable 560. In yet another embodiment, the implant deploymentmechanism 500 may include an axle/cam mechanism (not shown). The surgeonmay choose from a series of suture or cabling materials that havediameters allowing passage through the inserter 200 and cable receivingholes in the implant 100. Each of these materials has an intrinsictensile strength with differing loads to failure. In one embodiment, theimplant deployment mechanism 500 may be calibrated to match the varioustensile strengths of the suture/cabling material. In a more specificembodiment, the tension knob 550 may be designed to provide audiblesounds, “clicks” for example. As the tension knob 550 is rotated, it mayprovide a first audible sound that signifies that the implant 100 hasbeen deployed. As the tension knob 550 is rotated further, it mayprovide a second audible sound that signifies that the cabling materialis about to fail.

With reference now to FIG. 20E, in another embodiment the tension forceactivator 530 includes a tension trigger mechanism 850. The tensiontrigger mechanism 850 may include a body 852, a hold member 854 and atrigger 856. The trigger 856 may have an attachment surface 858 at afirst end that is used to attach to and move the cable 560. The cable560 may be attached to the trigger 856 in any manner chosen with thesound judgment of a person of skill in the art. At the second end, thetrigger 856 may have a grip surface 860. Between its ends, the trigger856 may be pivotally connected, such as with a pivot pin 862, to thebody 852 or to the hold member 854. The distal end of the body 852 maybe connected to the proximal end of the handle 302 in any manner chosenwith the sound judgment of a person of skill in the art. The body 852may have an opening 864 that is collinear with the opening 304 formed inthe handle 302. To increase the tension force on the cable 560 duringsurgery, the surgeon simply places the grip surface 860 of the trigger856 in his/her palm, places his/her fingers on the hold member 854 andsqueezes. This squeezing causes the second end of the trigger 856 tomove in distal direction B and to thus pivot the trigger 856 about pivotpin 862. This motion in turn causes the attachment surface 858 to movein proximal direction A until the attachment surface 858 exerts atension force on the cable 560. Continued squeezing of the trigger 856causes the cable 560 to move in the proximal direction A so that thedistal end of the cable 560 can exert a tension force on the implant100.

With reference now to FIGS. 2 and 26-33, the inserter 200 of thisinvention may also include an implant anti-deployment mechanism 600 thatprevents the implant deployment mechanism 500 from operating until thesurgeon is ready to operate it. In one embodiment, the implantanti-deployment mechanism 600 includes a tube member 620 that may beadjusted by the surgeon to permit operation of the implant deploymentmechanism 500. The tube member 620 may be generally cylindrical and mayhave an opening 622 throughout its length. This opening 622 may bepositioned substantially in the radial center of the tube member 620 andmay receive the grip activator 460. The proximal end of the tube member620 may have two or more arms 624, four shown, separated by a space 626between the arms 624. A threaded region 628 may be formed on the outersurfaces of the arms 624 to receive a securing device, which in oneembodiment includes a nut 650 as shown in FIGS. 2 and 27-28. The nut 650may be generally cylindrical and may have an opening 652 throughout itslength that may be positioned substantially in the radial center of thenut 650 and may be used to receive the tube member 620, as shown. Thenut 650 may have an outer surface having a textured region 654 toimprove the grip for the surgeon. The opening 652 may have a threadedregion 656 that engages the threaded region 628 of the tube member.

With continuing reference to FIGS. 2 and 26-33, the tube member 620 mayhave a generally circumferential extending surface 630 distallypositioned from the threaded region 628 that extends from the outersurface of the tube member 620. The extending surface 630 may serve twofunctions. First, it may act as a motion limiter to limit the movementof the nut in the distal direction B once the nut 650 has beendisengaged from the threaded region 628 of the tube member 620. Thesecond function of the extending surface 630 is to serve as a texturedregion to improve the grip for the surgeon when the surgeon is movingthe tube member 620. The distal end of the tube member 620 may beadapted to prevent the implant deployment mechanism 500 from operatingby interfering with the implant 100. In a specific embodiment, a clip632 extends from the distal end of the tube member 620 and it contactsthe implant 100, as shown in FIG. 30, preventing the implant 100 frombeing deployed. In yet a more specific embodiment, shown best in FIG.31, the distal end of the clip 632 may be sized to be received withinthe gap 434 formed in the hand 428. This provides for a securearrangement and minimizes the required length of the clip 632. The gap434 also provides a resting place for the clip 632, also shown in FIG.31, as the tip of the clip 632 rests on the hand 428 at the proximal endof the gap 434 after the tube member 620 has been adjusted to permitdeployment of the implant 100. The clip 632 may have three sectionsalong its length, a proximal section 631, a mid-section 633, and adistal section 635. The proximal section 631 is attached to the tubemember 620 and is at the same radial position as the tube member 620.The mid-section 633 is relatively radially inward and has an innersurface 636 that contacts the outer surface of the grip activator 460.The distal section 635 extends even farther radially inward to contactthe implant and to rest against the hand 428, as described above.

With reference now to FIGS. 2, 30-48 and 50-51, the inserter 200 of thisinvention may be used to insert and, if required, deploy any implantchosen with the sound judgment of a person of skill in the art. Theimplant may be, for non-limiting examples, any of the implants describedin commonly owned U.S. patent application Ser. No. 11/236,068,publication number US 2007/0073398, published on Mar. 29, 2007, titledSPINE SURGERY METHOD AND IMPLANT, which is incorporated herein byreference. While the embodiments discussed below are to implants havingfour outer posts, it should be understood that other post arrangementsare also contemplated. In one embodiment, for example, more than fourposts may be used. In another embodiment, less than four posts may beused. In yet another embodiment, one of the posts (or the only post orcentral support structure) is positioned substantially in the axialcenter of the implant. In this case it may be desirable to contact thecentral post for insertion purposes and/or for deployment purposes.

With continuing reference to FIGS. 2, 30-48 and 50-51, as noted abovewith regard to the rod or wire 520, in one embodiment a given implantmay be deployed by exerting a compression force on some portion of theimplant. Two specific wire deployed implants will now be described. Inboth cases, as shown by comparing FIG. 30 with FIG. 32 and by comparingFIG. 50 with FIG. 51, the implant 100 may deploy by rotating one portionof the implant with respect to the other to expand the effective surfacearea of the implant 100. Also in both cases, the implant is formed ofupper limbs 104 and lower limbs 106 connected to each other with fourposts 110.

The first embodiment is shown in FIGS. 32-33. For this embodiment thewire 520 takes a linear path as it exits the inserter 200 and contactsthe implant 100. In one specific embodiment, the post 110 gripped by thegripper 420 has a linear opening 114 that receives the wire 520 when itis extended out from the inserter 200. Continued extension of the wire520 causes the distal end of the wire 520 to contact another implantsurface, such as another post 110, to cause the implant 100 to deploy.

The second embodiment is shown in FIGS. 50-51. For this embodiment thewire 520 takes a curvilinear path as it contacts the implant 100. In onespecific embodiment, the post 110 gripped by the gripper 420 has acurvilinear opening 116 that receives the wire 520 when it is extendedout from the inserter 200. Continued extension of the wire 520 causesthe distal end of the wire 520 to contact another implant surface, suchas another post 110, to cause the implant 100 to deploy. In a morespecific embodiment, the portion of the implant 100 that contacts thedistal end of the wire 520 has a divot 118 on its surface that matchesthe surface shape of the distal end of the wire 520. In this way, thedistal end of the wire 520 is received in the divot 118 making it easierfor the wire 520 to stay in contact with the implant surface as it movesthrough the curvilinear motion.

With reference now to FIGS. 34-46, as also noted above with regard to acable 560, in another embodiment a given implant may be deployed byexerting a tension force on a cable to cause the implant to deploy. Twospecific cable deployed implants will now be described. In both cases,as with the previous embodiments, the implant 100 may deploy by rotatingone portion of the implant with respect to the other to expand theeffective surface area of the implant 100. Also, the implant 100 isformed of upper limbs 104 and lower limbs 106 connected to each otherwith four posts 110. For the embodiment shown in FIGS. 34-37, only twoof the posts 110 are used to deploy the implant 100. For the embodimentshown in FIGS. 38-46, three of the posts 110 are used to deploy theimplant 100. In both cases the posts 110 required for deployment havepost holes 112 that receive the cable 560 in any manner chosen with thesound judgment of a person of skill in the art.

With reference now to all the FIGURES but especially FIG. 2, theoperation of the inserter 200 of this invention will now be described.First, the surgeon decides what type, style and size of implant to beinserted. The surgeon then assembles the appropriate inserteraccordingly. It should be noted that the same handle mechanism 300 canbe used with numerous implant gripping mechanisms and, if required,numerous implant deployment mechanisms and implant anti-deploymentmechanisms. If a compression force member such as rigid wire 520 is tobe used as the implant deployment mechanism 500, the inserter 200 can beassembled and the rigid wire 520 can be inserted and positioned into thehandle opening 304, the connector opening 362, and the gripper opening422. If a tension force member such as cable 560 is to be used as theimplant deployment mechanism 500, the cable 560 can be attached to theimplant (in the non-deployed condition) and then inserted through thegripper opening 422, the connector opening 362, and the handle opening304. With the cap 580 removed, the cable 560 can then be connected tothe implant deployment mechanism 500 in a manner consistent with thetension force activator 530 being used. The cap 580 can then beattached.

With continuing reference to all the FIGURES but especially FIGS. 1A, 1Band 47-48, with the inserter 200 of this invention the vertebral space22 may be approached using universally accepted methods foranterolateral, posterior, or posterolateral (transforaminal) discectomy.Assuming a standard approach to the posterior/posterolateral annulus ofthe targeted disc, appropriate retraction of the neighboring neuralstructures is accomplished with universally available nerve rootretractors. For a posterior/posterolateral approach this would includeretraction of the dural sac towards the midline and retraction of theadjacent cephalad and caudad nerve roots, as would normally be done forroutine discectomy. Upon isolating the annular surface of the targeteddisc or targeted vertebra, variable needle sounds are placed in thevertebral space 22 with a range of radii of curvature. The range ofthese sounds would have been selected on the basis of pre-operativetemplating of available imaging studies, including plain radiographs, CTor MRI imaging. This preoperative templating provides a narrower rangeof radii for intraoperative confirmation, decreasing trial and errorsounding. The objective of this intraoperative needle sound placement isto locate the center of the vertebral space 22. The placement of thissound would be confirmed via biplanar intraoperative fluoroscopicimaging.

Still referring to all the FIGURES but especially FIGS. 1A, 1B and47-48, once the surgeon is satisfied with the centralization of theneedle tipped sound, routine discectomy is carried out using universallyaccepted instruments. The vertebral space 22 is then initiallydistracted with short, straight interbody spacers, progressively sizeduntil sufficient annular tension is achieved. Once this point isreached, longer, variable radii, curvilinear box chisels may be advancedinto the vertebral space 22 to remove disc and/or vertebral material andcartilaginous endplate. Once a majority of intradiscal material isremoved, an endplate cutter may be advanced to the entry point to makegraduated cuts in the periphery of the endplate to remove the normalconcave tapering of the bony endplate towards the periphery of thevertebrae. This process would insure true distraction of the vertebralspace 22 from the center. A distracter is then placed within thevertebral space 22 and distraction to the selected level of annulartension is achieved. The degree of this distraction would be based onsurgeon preference and/or the vertebral space 22 height of neighboringnon-degenerative discs or vertebra. With this optimal distraction,further discectomy, or removal of disc material, may be accomplished.The distracter is then placed at the presumed center of the vertebralspace 22 and centralized placement confirmed by intraoperativefluoroscopic imaging. Adjustments, if necessary, may be made inanterior-posterior and medial-lateral orientation until centralizationof the distracter is confirmed. The distracter used may be of any typeor style chosen with the sound judgment of a person of skill in the art.A non-limiting example is the distracter as described in commonly ownedU.S. patent application Ser. No. 11/756,168, titled SPINE SURGERY METHODAND INSTRUMENTATION, which is incorporated herein by reference.

With reference now to all the FIGURES, the implant 100 is then affixedto or gripped by the inserter 200 with the implant gripping mechanism400. In one embodiment, to activate the gripper 420 to grip the implant100, the surgeon grips the textured region 464 of the grip activator 460with one hand and, while holding the handle 302 with the other hand,rotates the grip activator 460 about its longitudinal axis in a firstdirection D1, as shown in FIG. 18. This causes the grip activator 460 tomove longitudinally in the distal direction B with respect to thegripper 420 as the threaded region 466 of the grip activator 460 mesheswith the threaded region of the gripper. 420 in a known manner. As thegrip activator 460 moves in distal direction B, it contacts the outersurfaces of the arms 426, 427, causing the arms 426, 427 as well as thehands 428, 429 to “squeeze” or move towards each other to thereby grip aportion, one of the posts 110 for example as shown in FIG. 30, of theimplant 100. The surgeon can continue to rotate the grip activator 460until the implant 100 is sufficiently gripped for surgery.

With continuing reference to all the FIGURES, the inserter 200 is thenmoved to insert the implant 100 within the vertebral space 22. Ifnecessary, a surgical mallet or slap hammer may be used to transferforces to the cap 580 to advance the implant 100 to the proper location.Biplanar fluoroscopic imaging may be used to confirm proper positioningof the implant 100. Adjustments, if necessary, can be made at this timeby adjusting the amount of distraction and/or orientation of thedistracter in the axial or frontal planes.

Still referring to all the FIGURES, if no deployment is required, theinserter 200 and distracter can be removed and bone grafting iscompleted by packing in the open profile of the implant 100. Ifdeployment is required, the implant deployment mechanism 500 must beactivated. However, if an implant anti-deployment mechanism 600 is used,it must first be adjusted by the surgeon to permit deployment. FIG. 30shows the implant anti-deployment mechanism 600 positioned to preventimplant deployment. In one specific embodiment, the surgeon grips thetextured region 654 of the nut 650 with one hand and, while holding thehandle 302 with the other hand, rotates the nut 650 about itslongitudinal axis in a first direction R1 as shown in FIG. 27. Thiscauses the nut 650 to move longitudinally in the distal direction B withrespect to the tube member 620 as the threaded region 558 of the nut 650meshes with the threaded region of the tube member 620 in a knownmanner. As the nut 650 moves in distal direction B, it releases or“un-tightens” from the tube member 620. The surgeon can then let go ofthe nut 650 (its motion is limited by the extending surface 630) andgrip instead the tube member 620 (at the extending surface 630, ifdesired) and move it in proximal direction A, as shown in FIGS. 32 and33. As the tube member 620 moves in proximal direction A, the clip 632moves out of contact with the implant 100 permitting deployment of theimplant 100. FIGS. 31-32 show the implant anti-deployment mechanism 600adjusted to permit implant deployment.

With continuing reference to all the FIGURES, after the implantanti-deployment mechanism 600 is adjusted to permit deployment (or, ifno implant anti-deployment mechanism 600 is used), the implantdeployment mechanism 500 can be activated. If a compression force membersuch as rigid wire 520 is used as the implant deployment mechanism 500,the wire 520 is extended out of the distal end of the gripper opening422 where it contacts and deploys the implant 100 in a manner consistentwith the particular compression force activator 700 that is used. If atension force member such as cable 560 is used as the implant deploymentmechanism 500, the cable 560 is tensioned to deploy the implant 100 in amanner consistent with the particular tension force activator 530 thatis used.

Still referring to all the FIGURES, at this point, confirmation ofsatisfactory implant 100 alignment within the vertebral space 22 may beconfirmed by intraoperative biplanar fluoroscopic imaging. Adjustments,if necessary, can be made at this time by changing the degree ofdistraction and medial-lateral and anterior-posterior translation of theimplant 100 by impaction/retraction or rotation with the inserter 200still in place. Once satisfactory implant 100 alignment is achieved, itmust be released from the implant gripping mechanism 400. In oneembodiment, to activate the gripper 420 to release the implant 100, thesurgeon grips the textured region 464 of the grip activator 460 with onehand and, while holding the handle 302 with the other hand, rotates thegrip activator 460 about its longitudinal axis in a second direction D2,as shown in FIG. 18. This causes the grip activator 460 to movelongitudinally in the proximal direction A with respect to the gripper420 as the threaded region 466 of the grip activator 460 meshes with thethreaded region of the gripper 420 in a known manner. As the gripactivator 460 moves in proximal direction A, it moves out of contactwith the outer surfaces of the arms 426, 427, permitting the arms 426,427 as well as the hands 428, 429 to move away from each other tothereby release the implant 100. The inserter 200 is then removedfollowed by the distracter. With the implant 100 now inserted, bonegrafting is completed by packing in the open profile of the implant 100.

With continuing reference to all the FIGURES, all the implantembodiments may be formed of any material that is appropriate forinsertion into an vertebral space, including, but not limited to metal,metal alloy, titanium, titanium alloy, ceramic, carbon-fiber, PEEK orany other osteobiologic or inert, biocompatible material. All theinserter embodiments may be formed of any biocompatible materialsuitable for surgical instruments.

With continuing reference to all the FIGURES, the lengths of the variousinserter components may be varied depending on patent parameters (suchas patient size) and whether the spinal surgery is done open or via MIStechniques. In one specific embodiment, connectors 360 of variouslengths may be provided. In this ease, the remaining components (handle302, gripper 420, etc.) can be of the same length but be used withconnectors 360 of different lengths in order to accommodate the specificpatent and surgery methodology.

Numerous embodiments have been described, hereinabove. It will beapparent to those skilled in the art that the above methods andapparatuses may incorporate changes and modifications without departingfrom the general scope of this invention. It is intended to include allsuch modifications and alterations in so far as they come within thescope of the appended claims or the equivalents thereof.

1-37. (canceled)
 38. A surgical system for use with an associatedintradiscal space comprising a first vertebral body having a firstendplate and a second vertebral body adjacent the first vertebral bodyhaving a second endplate, the surgical system comprising: an implantcomprising: (a) a first portion having a first opening; (b) a secondportion; (c) wherein the first and second members define first andsecond contact surfaces that contact the first and second endplates,respectively; (d) (d) wherein the implant is deployable by moving thesecond portion with respect to the first portion; and, a surgicalinserter that inserts the implant into the associated vertebral spaceand deploys the implant within the associated vertebral space, theinserter comprising: (a) a handle; (b) an implant gripping mechanismcomprising: a gripper having a first end attached to the handle and asecond end having a pair of arms that can grip and release the firstportion of the implant, the gripper also having an opening; and, (c) animplant deployment mechanism comprising: (1) a tension force member thatis attached to the second portion of the implant, wherein at least aportion of the tension force member is received within the first openingin the first portion of the implant, and wherein at least a portion ofthe tension force member is received within the opening in the gripper;and, (2) a tension force activator attached to the handle that applies atension force to the tension force member to pull the tension forcemember through the first opening in the first portion of the implant,and through the opening in the gripper to deploy the implant, while thegripper grips the first portion of the implant, by moving the secondportion of the implant with respect to the first portion.
 39. Thesurgical system of claim 38 wherein the implant deploys by rotating thesecond portion with respect to the first portion.
 40. The surgicalsystem of claim 38 wherein: the first portion of the implant has asecond opening; and, at least a portion of the tension force member isreceived within the second opening in the first portion of the implant.41. The surgical system of claim 38 wherein: the second portion of theimplant has a first opening; and, at least a portion of the tensionforce member is received within the first opening in the second portionof the implant.
 42. The surgical system of claim 38 wherein: the firstportion of the implant comprises first and second posts; the firstopening in the first portion is formed in the first post; a secondopening in the first portion is formed in the second post; and, at leasta portion of the tension force member is received within the secondopening in the second post.
 43. The surgical system of claim 38 whereinthe opening in the gripper is formed substantially in the radial centerof the gripper.
 44. The surgical system of claim 38 wherein: the handlehas an opening formed substantially in the radial center of the handle;and, the tension force activator applies a force to the tension forcemember to extend at least a portion of the tension force member throughthe handle opening. 45-68. (canceled)
 69. The surgical system of claim38 further comprising an anti-deployment mechanism comprising: a tubemember having an opening that receives the gripper and the tension forcemember; a clip the extends from the tube member; and, wherein theanti-deployment mechanism is adjustable between: (1) a first positionwhere the clip contacts the implant while the gripper grips the firstportion of the implant to prevent the implant from deploying bypreventing the second portion of the implant to move with respect to thefirst portion; and, (2) a second position where the clip does notcontact the implant while the gripper grips the first portion of theimplant and the implant is deployable by permitting the second portionof the implant to move with respect to the first portion.
 70. Thesurgical system of claim 69 wherein: the tube has a threaded region; theanti-deployment mechanism further comprises a nut having a threadedregion that meshes with the threaded region of the tube; and, the nut isrotatable in a first direction with respect to the threaded region ofthe tube to maintain the anti-deployment mechanism in the first positionand a second direction with respect to the threaded region of the tubeto permit the anti-deployment mechanism to be adjusted into the secondposition.
 71. The surgical system of claim 38 wherein the tension forceactivator comprises: a screw that is operatively connected to the handleand that has a threaded region; a tension knob having an opening that isat least partially defined by a threaded region that engages thethreaded region of the screw; wherein the handle, the screw, and thetension knob each have an opening that receives the tension forcemember; and, wherein the tension knob is rotatable with respect to thescrew to apply the tension force to the tension force member to deploythe implant.
 72. A spine surgery method comprising the steps of: (A)providing an implant comprising: a first portion having a first opening;and, a second portion that is moveable with respect to the firstportion; wherein the first and second members define first and secondcontact surfaces; (B) providing a surgical inserter comprising: (a) ahandle; (b) an implant gripping mechanism comprising: a gripper having afirst end attached to the handle and a second end having a pair of arms;and, (c) an implant deployment mechanism comprising: (1) a tension forcemember that is attached to the second portion of the implant, wherein atleast a portion of the tension force member is received within the firstopening in the first portion of the implant, and wherein at least aportion of the tension force member is received within the opening inthe gripper; and, (2) a tension force activator attached to the handle;(C) removing at least one spinal disc to create an intradiscal spacebetween two adjacent vertebrae that define first and second endplates,respectively; (D) gripping the first portion of the implant with thepair of arms of the gripper; (E) replacing the at least one spinal discwith the implant by inserting the implant within the intradiscal spacewith the surgical inserter while the pair of arms of the gripper gripthe first portion of the implant so that the first contact surface isadjacent the first endplate and the second contact surface is adjacentthe second endplate; (F) deploying the inserter within the vertebralspace by operating the tension force activator to apply a tension forceto the tension force member to pull the tension force member through thefirst opening in the first portion of the implant and through theopening in the gripper to deploy the implant by moving the secondportion of the implant with respect to the first portion while the pairof arms of the gripper grips the first portion of the inserter; and, (G)releasing the first portion of the inserter with the pair of arms of thegripper.
 73. The spine surgery method of claim 72 wherein step (F)comprises the step of: rotating the second portion of the implant withrespect to the first portion.
 74. The spine surgery method of claim 72wherein: step (A) comprises the step of: providing the first portion ofthe implant with a second opening; step (B) comprises the step of:providing the tension force member to be received within the secondopening in the first portion of the implant; and, step (F) comprises thestep of: pulling the tension force member through the second opening inthe first portion of the implant.
 75. The spine surgery method of claim74 wherein: step (A) comprises the steps of: providing the first portionof the implant with first and second posts; providing the first openingin the first portion in the first post; and, providing a second openingin the first portion in the second post.
 76. The spine surgery method ofclaim 72 wherein: step (A) comprises the step of: providing the secondportion of the implant with a first opening; step (B) comprises the stepof: providing the tension force member to be received within the firstopening in the second portion of the implant; and, step (F) comprisesthe step of: pulling the tension force member through the first openingin the second portion of the implant.
 77. The spine surgery method ofclaim 72 wherein: step (B) comprises the step of: providing the handlewith an opening formed substantially in the radial center of the handle;and, step (F) comprises the step of: pulling the tension force memberthrough the opening in the handle.
 78. The spine surgery method of claim72 wherein: step (B) comprises the steps of: (a) providing the surgicalinserter with an anti-deployment mechanism comprising: a tube memberhaving an opening that receives the gripper and the tension forcemember; and, a clip the extends from the tube member; and, (b) adjustingthe anti-deployment mechanism into a first position where the clipcontacts the implant while the gripper grips the first portion of theimplant and prevents the implant from deploying by preventing the secondportion of the implant to move with respect to the first portion; and,prior to step (F), the method comprises the step of: adjusting theanti-deployment mechanism into a second position where the clip does notcontact the implant while the gripper grips the first portion of theimplant and the implant is deployable by permitting the second portionof the implant to move with respect to the first portion.
 79. The spinesurgery method of claim 78 wherein: step (B) comprises the steps of: (a)providing the tube member with a threaded region; and, (b) providing theanti-deployment mechanism with a nut having a threaded region thatmeshes with the threaded region of the tube; the step of adjusting theanti-deployment mechanism into the first position comprises the step of:rotating the nut in a first direction with respect to the threadedregion of the tube; and, the step of adjusting the anti-deploymentmechanism into the second position comprises the step of: rotating thenut in a second direction with respect to the threaded region of thetube.
 80. The spine surgery method of claim 72 wherein: step (B)comprises the steps of: (a) providing the tension force activator tocomprise: a screw that is operatively connected to the handle and thathas a threaded region; and, a tension knob having an opening that is atleast partially defined by a threaded region that engages the threadedregion of the screw; and, (b) providing each of the handle, the screw,and the tension knob with an opening that receives the tension forcemember; and, step (F) comprises the step of: rotating the tension knobwith respect to the screw to apply the tension force to the tensionforce member to deploy the implant.